Roach: Back pain is hard to diagnose definitively

Dear Dr. Roach: I have had back pain on and off for years. It does seem to get worse when I am under stress at work. My doctor took blood tests and X-rays, and can’t find anything wrong. He hasn’t said so, but I think he doesn’t believe that I have real pain and thinks it’s all in my head. What should I do?— N.D.

Yours is a not-uncommon problem. Most cases of back pain do not have a clear diagnosis after diagnostic testing. Many patients are convinced that the problem must be findable, so they want to get a CT scan or an MRI to prove that there is something wrong. However, even these tests often show no significant problems.

Does that mean the pain isn’t real? Of course not. Subtle injuries and degenerative changes in the bones, muscles, ligaments and other structures certainly can be the cause of pain and also not show up in testing. However, as you have suggested, mental stress can make any kind of pain worse, but that seems especially true for back pain. There are physical and psychological reasons for this increase in pain. One physical reason is that less and poor-quality sleep during times of stress can make back symptoms worse. Depression, anxiety and some personality issues are associated with higher risk of back pain.

In my experience, the most effective long-term treatment for chronic back pain, after a thorough workup has been done to exclude those few cases of back pain that require surgery, is regular physical activity. For many people, a physical therapist can be invaluable in helping design a course of activity that can keep the pain at a bearable level and allow them to continue leading their lives. Medication should be kept to the lowest amount that gives acceptable pain relief.

Dear Dr. Roach: I am 51 years old. My sister, at age 53, had a non-cancerous tumor removed from her pancreas. I got a CA 19-9 blood test last year, which was 55, and this year, it is 52. I had an MRI, and everything is fine. I am not sure if I should do more testing to make sure everything is still OK, or wait and see next year. — C.S.W.

CA 19-9 is a substance secreted by some, but not all, pancreatic cancers. It is most useful in people who have had a diagnosis of pancreatic cancer. If the level is high, it can be followed as a guide to the amount of tumor in the body and to determine if therapy is effective.

However, it is not very useful as a screening test for pancreatic cancer, because some people have detectable levels for no clear reason. In one study of 71,000 healthy people without symptoms, about 1,000 had a level above 37 — and only four of those people had pancreatic cancer. Unless you have some other reason to get this test done you haven’t told me about, I would not recommend getting the test. It causes more worry than it’s worth.

DR. KEITH ROACH has taken over the health column that appears three times weekly in the A-J, following the retirement of Dr. Paul Donohue. Dr. Roach is a syndicated columnist with North America Syndicate Inc., P.O. Box 536475, Orlando, FL 32853-6475.